胃镜取上消化道异物112例体会

我院从2000年至2005年,共用电子胃镜取上消化道异物112例,经急诊胃镜取出104例,失败2例,效果良好。胃镜取异物具有方便快捷、价廉、创伤小等优点,值得推广,现将取得的经验操作体会报告如下。1资料与方法1.1一般资料本组中男74例,女38例,年龄2岁~65岁,平均年龄42岁,10岁以下儿童为17例,112例中咽部异物17例,均为鱼刺,食道异物35例,胃内异物56例,十二指肠球部异物2例,降部异物2例,除外咽部17例鱼刺,所剩95例中难取异物44例,其中带钩义齿11例,刀片8例,玻璃片6例,铁片3例,铁钉2例,铁勺2例,戒指2例,枣核1例,牙刷4例,方便筷2例,围棋3例。1.2器械OLYMPUS电子胃镜、活检钳、鼠齿钳、网篮、胃镜套管、自制的内镜前端保护套(制作方法:将避孕套前端剪开尾端固定在镜头前方1cm并反折,用一皮圈固定外接一拉线,使用石蜡油润滑)。1.3操作方法1.3.1术前准备详细询问病史,了解异物的大小、形状、材质,并行拍片进一步了解有无气腹症及异物所处位置及性状。对锐利者准备好保护装置,胃内食物较多者嘱其平卧,禁食水,保持平静,必要时用X线透视动态了解异物是否移动。1.3.2麻醉采用利多卡因...     

Risk factors for anal sphincter tears: the importance of maternal position at birth

Objective  To assess the role of birth position in the occurrence of anal sphincter tears (AST).
Design  Observational cohort study.
Setting  South Hospital in Stockholm, a teaching hospital with around 5700 births per year.
Population  Among all 19 151 women who gave birth at the South Hospital during the study period 2002–05, 12 782 women met the inclusion criteria of noninstrumental, vaginal deliveries.
Methods  Data on birth position and other obstetric factors were analysed in relation to occurrence of AST.
Main outcome measure  Third- and fourth-degree AST.
Results  AST occurred in 449 women (3.5%). The trauma was more frequent in primiparous (5.8%) than in multiparous women (1.7%). The highest proportion of AST was found among women who gave birth in lithotomy position (6.9%), followed by squatting position (6.4%). Logistic regression analyses showed that lithotomy (adjusted OR 2.02, 95% CI 1.58–2.59) and squatting positions (adjusted OR 2.05, 95% CI 1.09–3.82) were associated with a significantly increased risk for AST. Other major risk factors for anal sphincter trauma were primiparity (adjusted OR 3.29, 95% CI 2.55–4.25), prolonged second stage of labour >1 hour (adjusted OR 1.52, 95% CI 1.11–2.10), infant birthweight more than 4 kg (adjusted OR 2.12, 95% CI 1.64–2.72) and large infant head circumference (adjusted OR 1.57, 95% CI 1.23–1.99).
Conclusion  Lithotomy and squatting position at birth were associated with an increased risk for AST also after control for other risk factors.     

Control accuracy and response time in multiple-state myoelectric control of upper-limb prostheses. Initial results in nondisabled volunteers

In myoelectrically operated prosthetic systems control performance decreases with an increasing number of possible movements. A test has been designed that allows quantification of two related qualities of performance. A predefined amount of training was given to 40 nondisabled volunteers without previous prosthetic experience. After training they attempted the test. The two parameters measured were the response time and the control accuracy corresponding to the different movements. It is concluded that even with a very limited amount of training fairly complex control systems can be operated with acceptable performance.     

高肺容积部分平均通过时间的测定方法和临床意义

介绍了用力呼气肺量图高肺容积部分平均通过时间(MTTp-h)的测定方法,并对100例正常人和94例气道阻塞疾病(支气管肺癌、喉癌和慢性支气管炎)患者进行了测定。初步认为MTTp-h对检测大气道和上气道阻塞敏感性较高,可作为协助临床诊断的实验室指标。     

控制性肺膨胀在食管癌术后应用的临床对比研究

目的　观察在食管癌术后应用控制性肺膨胀防止急性呼吸衰竭的疗效。方法　随机设立应用控制性肺膨胀组 4 3例和对照组 33例 ,年龄和手术时间等无显著差异。观察撤离呼吸机时间。撤机后 1 2、2 4h的呼吸频率、心率、血氧饱和度和氧分压。结果　 (1 )应用控制性肺膨胀后 ,撤机时间由 (1 0 4± 1 5 )min缩短到 (87± 1 3)min。 (2 )撤机后 1 2h ,控制性肺膨胀组血氧饱和度和氧分压异常的患者率分别由 30 .30 %下降到 6 .98% ,2 4 .2 4 %下降到 6 .98%。 (3)撤机后 2 4h ,血氧饱和度异常的患者率由1 8.1 8%下降到 2 .33%。结论　食管癌术后应用控制性肺膨胀能有效防止急性呼吸衰竭的发生。     

心电图短P-R间期观测研究

目的：探讨和鉴别心电图短Ｐ－Ｒ间期的产生原因，为临床诊断、治疗提供依据。方法：检测１１５例受检者的常规导联心电图（ＲＬＥＣＧ）、头胸导联心电图（ＨＣＥＣＧ）、食管导联心电图（ＥＬＥＣＧ），对其中５５例临床可疑心律失常和ＲＬＥＣＧ示短Ｐ－Ｒ间期者行食管心房调搏电生理检查。结果：①Ｐ波出现率和振幅均值比较ＥＬＥＣＧ＞ＨＣＥＣＧ＞ＲＬＥＣＧ（Ｐ＜０．０１），出现率分别为１００％、９５％、９１％。②ＨＣＥＣＧＰ－Ｒ段均值（Ｐ＜０．０１）及变异系数＜ＲＬＥＣＧ。③ＲＬＥＣＧ波幅低、图形多变是产生心电图短Ｐ－Ｒ间期的主要原因。结论：作为无创伤性检查方法，ＨＣＥＣＧ和ＥＬＥＣＧ可以对短Ｐ－Ｒ间期者进行初步筛选，而经食管心房调搏能检测ＥＣＧ短Ｐ－Ｒ间期的电生理特性，对鉴别诊断有肯定价值。     

Traumatic or septic aortic regurgitation: diagnosis by oesophageal echocardiography

Severe aortic regurgitation was discovered in a young man 21 days after blunt chest trauma and after a prolonged febrile state with positive blood cultures. Using transoesophageal echocardiography (TEE), it was possible to make the differential diagnosis between traumatic rupture and endocarditis as the cause of valvular insufficiency. The use of TEE in the initial evaluation of severe thoracic trauma with an unclear clinical picture is recommended. This method is easy to use at the bedside and gives precise information on the aortic valve and the ascending aorta.     

Light and electron microscopic and autoradiographic studies onN-methyl-N-amylnitrosamine-induced rat esophageal carcinogenesis

The purpose of this study was to investigate the histogenesis of experimental tumors in the rat esophagus. Thirty rats received 0.0015% N-methyl-N-amylnitrosamine (MNAN) in the drinking water for 12 weeks. Another 30 rats received tap water. All rats then received tap water until sacrifice. Rats from each group were sacrificed immediately after MNAN administration, four weeks after, and eight weeks after. One hour before sacrifice, [³H]TdR was injected by tail vein to label proliferating cells. The entire esophagus and stomach were removed and processed for light and electron microscopy and autoradiography. The overall frequency of esophageal tumors after MNAN was 83% and did not differ significantly among the three experimental groups. Tumors were primarily papillomas and squamous cell carcinomas and occurred with equal frequency in the upper, middle, and lower thirds of the esophagus. No tumors were found in the squamous-lined forestomach. Electron microscopy revealed abundant tonofilaments, free ribosomes, and mitochondria accompanied by vacuoles. By autoradiography, esophageal epithelial proliferation was markedly stimulated in nontumorous mucosa from all three experimental groups. We conclude that MNAN ingestion for 12 weeks reliably produces papillomas and squamous cell carcinomas throughout the rat esophagus, but not in the squamouslined forestomach, and that MNAN stimulated marked epithelial proliferation which is accompanied by thickening of the epithelium in nontumorus esophageal mucosa.     

食管内翻拔脱术治疗食管癌贲门癌19例分析

目的　探讨食管内翻拔脱术在食管癌、贲门癌外科治疗中的地位。方法　 19例食管癌、贲门癌病人接受了食管内翻拔脱术 ,其中食管鳞癌 15例 ,颈段 3例 ,胸中段 6例 ,胸下段 6例 ;贲门腺癌 4例。 0期 1例 ;Ⅰ期 4例 ;Ⅱa期 4例 ;Ⅱb期 1例 ;Ⅲ期 9例。 3例因有上消化道手术史行结肠代食管。结果　 19例均获切除 ,食管切缘阴性 ,无手术死亡。术后声音嘶哑 1例 ,心律失常1例 ,双侧胸腔积液 1例 ,左侧气胸伴左膈下脓肿 1例 ,5例出现小的颈部吻合口瘘。结论　食管内翻拔脱术扩大了食管癌、贲门癌的手术适应证 ,使某些常规手术高危患者重新获得手术机会。     

USEFULNESS OF EUS IN PORTAL HYPERTENSION WITH ESOPHAGEAL VARICES

We investigated the relationship between esophageal varices and the collaterals by endoscopy and endoscopic ultrasound (20 MHz ultrasonic miniprobe; UMP). Moreover, we investigated the correlation between the collaterals around the esophagus and recurrence of esophageal varices in patients with portal hypertension who had undergone EIS. The collaterals were divided into two groups: peri‐esophageal collateral veins (peri‐ECVs) and para‐esophageal collateral veins (para‐ECVs). These were scored as mild or severe according to the stage of development. According to endoscopy, the varix form was significantly larger in severe the peri‐ECVs group than in mild the peri‐ECVs group. The prevalence of perforating veins increased according to the varix form. With regard to variceal recurrence, in patients with variceal recurrences, UMP findings included a significantly higher incidence of severe peri‐ECVs, a significantly larger diameter of perforating veins compared with patients without recurrence. In conclusion, the presence of severe peri‐ECVs and large perforating veins in the esophageal wall strongly correlates with occurrence and recurrence of esophageal varices in patients with portal hypertension. An understanding of these UMP abnormalities on the basis of hemodynamics around the esophagus is thought to be important for management of esophageal varices in patients with portal hypertension.